Retinal Conditions

The Retina is the light sensitive tissue that lines the inside of the eye. It transmits light to the brain via the optic nerve.

The Macula is the functional center of the retina. It gives us the ability to see straight ahead, see small print and appreciate colors.

Light is normally focused onto our retina by our glasses, cornea and lens. Assuming that the retina is healthy, good vision should result. Macular diseases typically affect central vision. Retinal diseases may affect the peripheral vision, but may have an impact on central vision as well if the macula is involved.

Retinal disease can cause long-lasting and/or permanent damage to your eye and vision. Any symptoms of retinal conditions should be evaluated by a specially-trained physician.

Symptoms of retinal disease can include:

• A “curtain” over your eye
• Visual disturbances such as flashes or floaters
• Blurry or wavy vision

Macular degeneration is a chronic eye condition that involves the loss of central vision. Also known as Age Related Macular Degeneration (AMD or ARMD), the condition typically affects individuals over the age of 50 and is the leading cause of vision in people aged 55 years and older in the United States. In macular degeneration, the central part of the retina, also known as the macula, deteriorates, causing loss of central vision. The macula is the part of the retina that allows us to see color and detail. The loss of central vision affects many daily activities including reading, driving and watching TV.

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The experienced specialists at OMNI are specially trained in detecting changes in your eyesight even before you may notice a problem with your vision. Through advanced diagnostic techniques, our team of physicians has your best eye health in mind and will work closely with you in diagnosing and treating your macular degeneration.

Types of Age Related Macular Degeneration

Dry Macular Degeneration

Ninety percent of patients have the “dry” form of macular degeneration. This form is slowly progressive and patients rarely suffer from severe vision loss. In dry macular degeneration, the thinning or deterioration of the tissues of the macula and/or the appearance of abnormal yellow deposits or spots in the macula is thought to be the cause of this condition.

There is often little that needs, or can be, done to prevent this condition, although preventative measure earlier in life such as a healthy diet, exercise and wearing protective sunglasses may help.

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Wet Macular Degeneration

Only about 10 percent of patients suffer from the “wet” form of the disease, an advanced and damaging form of ARMD. In this form of macular degeneration, abnormal “leaky” vessels grow between the layers of the retina. This leakage of fluid severely damages the light-sensitive retinal cells, causing the development of blind spots in a person’s central vision. Substantial loss of central (e.g. reading) vision may be lost in a few weeks to months.

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How is ARMD Treated?

The physicians at OMNI Eye Specialists are committed to stay abreast of the latest in new, advanced therapies for treating macular degeneration, particularly for the “wet” form of the disease including:

• Ocular Photodynamic Therapy (OPDT)
  This treatment for wet AMD was approved several years ago and is the mainstay to treating patients with subfoveal choroidal neovascularization. It selectively inhibits growth of the abnormal blood vessels, thus usually preserving, and sometimes improving, central vision. Other treatments will be emerging in the next few years.
• Photodynamic Therapy (PDT) for the Treatment of Exudative ARMD
  Since the FDA approval of Visudyne (Verteporfin for injection, Novartis), Photodynamic Therapy (PDT) has become the mainstay of treatment for patients with the wet form of the disease that develop abnormal blood vessels underneath the macula. These patients usually respond well to this treatment. PDT involves injection of a medicine (Verteporphin) which accumulates in the abnormal vascular complex. This infusion occurs over a 10 minute period and affects only the abnormal tissue. This is beneficial as the therapy does not affect normal surrounding tissue, unlike treatments utilizing thermal lasers.

PDT usually needs to be repeated with most patients requiring three to four treatments over the first year and about two treatments over the second year. Significant preservation of vision can be achieved when adhering to this protocol. Many patients may also experience improved vision after the initial treatment, with subsequent treatments of PDT continuing to maintain improvement in vision.

• Vitamins and ARMD
  Vitamin supplementation has been proven helpful to only a small subset of patients with ARMD as described by the Age-Related Eye Disease Study (AREDS). Vitamins can reduce the chance of severe vision loss from choroidal neovascularization by 25%, but these effects are found only in the highest risk group. Advertisements for these nutritional supplements seem to indicate that vitamin supplementation is beneficial for all patients with macular degeneration. Bausch and Lomb originally formulated the vitamins used in the AREDS study. This formulation is sold over the counter as Ocuvite® PreserVision®. Other companies now market similar compounds.

Ask your OMNI Eye professional if this treatment option is right for you.

Other Treatments and Investigational Therapies for ARMD

• Classic photocoagulation using a thermal laser was the first line of treatment and was described in the Macular Photocoagulation Study Group in the early 1990s. Its main drawback is the formation of permanent black spots or “scotomas” in the patient’s vision. This is one reason why PDT has become so popular. Still, there are cases where this treatment may be preferred, for example, in cases where the neovascularization is not directly underneath the macula.
• Transpupillary Thermotherapy Technique (TTT) utilizes a lower energy diode laser to treat the neovascular complex. The adjacent cells may be left intact and undamaged. The exact mechanism of action is not known. It may be an attractive alternative to PDT as expensive injections are not needed. Similar techniques have been employed to treat ocular tumors such as retinoblastoma and choroidal melanoma.
• Feeder Vessel Treatment with High Speed ICG Angiography is currently under investigation. The dye, similar to fluorescein, is infused to identify a single feeder vessel. If a vessel can be identified and is treatable, the size or total area of treatment is smaller than compared to conventional methods. Treating only this area limits the amount of laser applied to the retina and thus minimizes scotoma formation.
• Rheopheresis is a method by which certain toxic substances are filtered from the bloodstream. Certain “vascular risk factors” are removed from the blood during treatment. There is evidence that suggests progression of the ARMD may be reduced if these factors, such as LDL cholesterol, fibrinogen and lipoprotein A are reduced. Rheopheresis is under investigation.

Promising alternative treatments will involve intravitreal drug injection and delayed intraocular delivery of key medicines that can further inhibit or destroy these “leaky” blood vessels. Present treatments are limited to those patients with the wet form of the disease. Several drugs are under investigation and may be approved for patient use in the next one to two years.

Diabetic retinopathy is a complication of diabetes (Type 1 or Type 2 diabetes) that causes damage to the blood vessels of the retina in the eye.

With diabetes, the body does not use and store sugar properly. High blood sugar levels create changes in the veins, arteries and capillaries that carry blood throughout the body. This includes the tiny blood vessels in the retina, the light-sensitive nerve layer that lines the back of the eye. Individuals who have had diabetes for a long time and/or have uncontrolled spikes in blood sugar are more prone to developing diabetic retinopathy.

Diabetic retinopathy often has no noticeable symptoms until it is too late to reverse or correct the damage done to the eye.

Diabetic retinopathy is the leading cause of new blindness in adults. In most cases, vision loss from diabetes can be prevented or restored if caught in time. Patients require routine examination with treatment applied before vision becomes blurry. Patients with diabetes should be examined at least once a year. Laser surgery is often needed to prevent vision loss in most diabetics.

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Retinal tears and detachment are serious eye conditions that require immediate medical eye care.

Retinal Tears

The back cavity of the inner eye is filled with vitreous, a clear jelly-like substance. The natural aging process can cause the vitreous jelly to deteriorate and become liquid. As the vitreous deteriorates with age, it can pull away from the retina and cause the retina to tear.

These tears usually occur in the peripheral retina having little effect on vision. Once a tear occurs in the retina, fluid from the vitreous can leak through the tear into the space between the retina and the wall of the eye. Left untreated, however, the retinal tears can lead to retinal detachment resulting in vision loss.

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Retinal Detachment

Retinal detachment must be treated early or it will lead to vision loss and possible blindness. Retinal detachment occurs when the retina separates from the back wall of the eye, reducing its blood supply and impairing the retina’s ability to process light rays. If total detachment occurs, the retina cannot function, resulting in blindness.

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Symptoms of Retinal Tears and Detachment

In many causes, retinal tears do not cause symptoms; however, the vitreous gel pulling away from the retina may cause some people to see flashes of light.

If retinal detachment occurs, you may experience:

• A wavy or watery quality to your vision
• A curtain or shadow across your field of vision
• Distorted or reduced central vision if detachment is in the macula
• Partial or total loss of vision

Who is at Risk for Retinal Tears and Detachment?

Retinal tears and detachment are a part of the normal aging process and can occur in people after the age of 40 years. In addition to age, some risk factors associated with retinal tears and detachment may include:

• People who are severely nearsighted
• People with a family history of retinal problems
• People who have undergone eye surgery
• People who have experienced a severe eye injury

Treatment for Retinal Tears and Detachment

Retinal tears require immediate treatment to prevent detachment and loss of vision. OMNI Eye Specialist’s retinal expert utilizes either a laser light or a freezing probe (cryopexy) to create a scar which welds the retina to the back of the eye to prevent further tearing. The scar seals the tear and blocks the fluid from passing under the retina. Retinal detachment also requires surgical repair to either restore vision or prevent further loss of vision.

Annual eye exams are important in preventing loss of vision and to maintain your eye health as you age. If you experience any symptoms of a retinal tear, it’s important to call a specialist right away to prevent further damage and detachment.